Despite years of controversy and volumes of polemics, studies comparing the clinical efficacy, cost, and cost-effectiveness of various options of methadone treatment for opioid abusers are lacking. Empirical assessments of these treatments are essential to guide public and private programs for drug treatment. They are also essential for establishing federal guidelines concerning what kind of methadone treatment options are available. The proposed research will test a series of hypotheses about the clinical efficacy, cost, and cost-effectiveness of long-term (180-day) methadone detoxification plus intensive psychosocial treatment versus methadone maintenance with a standard psychosocial treatment. This study has two interrelated foci. The first is to determine the relative efficacy of these two methadone treatments, the second is to compare the cost and cost-effectiveness of these treatments. One-hundred-fifty opioid-dependent individuals who are applying for methadone treatment at the San Francisco VA Medical Center will be stratified by gender and ethnicity, and randomly assigned from the stratified blocks to receive one the two treatment conditions. A complete instrument battery will be done at baseline. This battery includes demographic information, substance abuse history, addiction severity, assessment of commitment to abstinence, psychiatric diagnosis, risk assessment for HIV, craving and withdrawal scales, urine toxicology screens, breath tests for alcohol, and self-report measures of drug use. Research urine toxicology screens will then be performed weekly on a random basis for all subjects. Further assessments are made at 4-week intervals (weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52). These assessments include self-report and biochemical verification of drug use, withdrawal symptoms, craving, risk assessments for HIV, the Addiction Severity Index, measurement of treatment received, services utilized, costs accrued, and locator information. The ultimate goal of this line of research is to develop and to evaluate optimal substance abuse treatments for opioid dependence. The information gained from this investigation will provide a definitive comparison of the treatments studied and will suggest potential patient matching interactions for future patient treatment matching studies.